Health

Lessons in Confusion

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Many of you probably already know that Amazon.com is not just a seller of books. In fact, you know that you can buy almost anything from the online mega-store, including electronics, toys, games, gourmet food, kitchen and houseware items, apparel, accessories, jewelry, watches, sports and outdoor gear, beauty products, musical instruments, and, yes, even babies (Oh wait, I guess that tab means baby products). But, although remarkable, it isn't the seemingly unlimited variety of Amazon's product offerings that really knocks my socks off. What really astonishes me is just one product, and its current sales ranking: the Philips HeartStart Home Automated External Defibrillator (AED), which is the 62nd best selling product on Amazon.com in the "Health and Personal Care" category of products.1 Used to treat sudden cardiac arrest by delivering a shock to the heart, the product description on Amazon claims:

To put the sales ranking of 62 in perspective, I found that a set of eight "toe-separators" are the 19,258th best selling item in the "Health and Personal Care" category of products. Now, without dwelling on the nature of this fascinating product, let's just realize that this sales ranking demonstrates that there are at least 19,258 products in the Health and Personal Care "department" of Amazon.com.2

So that means that the $1,500 HeartStart Defibrillator is selling better than at least 99.5% of the 19,000+ health and personal care products on Amazon.com. Go down the list of bestselling health and personal care products, and you'll find diapers, toothbrushes, shaving systems, massage devices, and, oh yes, the "latest in essential safety equipment", the HeartStart Defibrillator.

Why am I telling you this? I'm telling you this because it supports some interesting observations. First off, our health stinks. The chief cause of cardiac arrest is coronary heart disease. Undoubtedly, most of the people who are buying the defibrillator either have diagnosed heart disease or are at very high risk for heart disease. The fact that the personal HeartStart Defibrillator sells as well as some toothbrushes and razors on Amazon.com, and defibrillators in general seem to be reproducing everywhere, from schools to airports to shopping malls, is merely one, albeit dramatic, example of how common heart disease is in the United States. I could name dozens of statistics that demonstrate the high prevalence of heart disease, some of which you've probably already heard.

But this is old news. Heart disease is the All-American disease, and it has been for decades. What actually interests me is something else, something slightly more obscured. There is a more fundamental disease, if you will, and it is far more problematic than heart disease itself. There are several symptoms of this fundamental illness and heart disease is only one of them. Other symptoms include various forms of cancer, stroke, diabetes, obesity, Alzheimer's, osteoporosis, kidney stones, gout, and other conditions. This fundamental, underlying disease plays the leading role in promoting almost all of our top ten leading causes of death in this country. It truly is deadly.

What is this underlying disease? Nutritional Confusionitis, which I shall define as: a foggy state of mind that renders the victim unable to place food and health information in a logical and clear context.

Nutritional Confusionitis is the most prevalent disease of all. One telephone survey3 of people in Minnesota found that, on average, people could recall only 2.5 of the 13 major guidelines in the 1995 Dietary Guidelines for America. In addition, only 17% of respondents knew how much dietary fat they should have in their diet, according to the dietary guidelines. Another recent article in the Journal of Nutrition4 cites surveys showing that almost 70% of Americans feel medical and health information in the media is contradictory and 80% of Americans think that, within the next five years, the so-called experts will change their minds about what foods are healthy. In Australia, which has a nutritional landscape not unlike ours, people who were surveyed5 about their changing eating patterns had a very poor idea of where folate and fiber come from in their diet, despite the substantial public push to increase consumption of these nutrients. These studies and others show that the vast majority of people generally don't know what the major guidelines are, what nutrients are in what foods, what the 'experts' believe, or even which 'experts' to trust.

But there's an even deeper problem, and it doesn't show up in surveys: the people who do know all of these things, the very people who are paid to come up with guidelines and provide health information, many of our academics, institution leaders, and doctors, are also afflicted with Nutritional Confusionitis. They can tell you all sorts of stuff about the nutrient content of foods, official guidelines for this, that, and everything else, and pills and procedures (in the case of the doctors), but they don't seem to know what diet is most effective at preventing and reversing heart disease, among other diseases.

For example, the Canadian National Institute of Nutrition (The US does not have a national institute of nutrition) has a webpage6 describing the possible benefits of a vegetarian diet. Regarding cardiovascular disease, it says, "Overall, a vegetarian diet appears to be heart healthy and related to lower blood pressure." It goes on to mention that research shows that vegetarians have a better cholesterol profile than non-vegetarians, and discusses several reasons why this may be the case. However, I get the sense that they are unsure of which mechanisms, exactly, contribute to making the diet safer, and, in fact, the second paragraph of the two paragraph explanation highlights a recent study that questions whether vegetarians really do have a better cholesterol profile. And that's it. That's all the information they offer about the potential benefits of a plant-based diet for cardiovascular disease.

Quite frankly, I can't possibly see how they might justify this wishy-washy, ambiguous, off-target review of the literature. For example, do they know that many traditional cultures that subsist mostly on plant-based diets simply do not have heart disease?7,8 Do they know that 30 years ago it was shown that people of similar genetic background (Japanese) were shown to have different cholesterol levels and heart disease incidence depending on whether they lived in America or Japan, and plant-based diets were linked to lower risk?9,10 Here's another one: half a century ago it was shown that, across countries, the percent of calories coming from animal protein was a good predictor of heart disease incidence in men in their early 50s.11 Do they know that multiple animal experiments and human experiments have shown that animal protein raises cholesterol levels and plant protein lowers cholesterol levels?12 Or how about that almost 50 years ago Dr. Lester Morrison of Los Angeles showed that people with advanced heart disease (they had already had a heart attack) could increase their chances of survival simply by eating a low cholesterol, low fat, 'moderately' plant-based diet?13 These findings were supported by another California study14 at about that time. This additional study had larger numbers of patients and the benefits were shown to be even greater. But even if they haven't heard of any of this research, surely the Canadian Institute of Nutrition must know about the more recent studies, done by Drs. Dean Ornish15 and Caldwell Esselstyn, Jr.16 that achieved some of the most dramatic heart disease reversal ever observed in the history of heart disease research using a plant based diet, along with lifestyle changes (in the case of Dr. Ornish) and a minimal amount of cholesterol lowering medication (in the case of Dr. Esselstyn).

There is an overwhelming amount of research supporting a plant-based diet for the prevention and reversal of heart disease, only a small sample of which is briefly mentioned above. Yet, despite this, the Institute of Nutrition in Canada can essentially only say that a vegetarian diet "appears" to be good for the heart, despite some apparent uncertainties in the research. Perhaps this organization is suffering from Nutritional Confusionitis.

Given that this illness of all illnesses sometimes even afflicts the top decision makers and information providers, it is very hard for everyday consumers to cure themselves of this horrible disease even if they diligently absorb and follow every official, 'credible' recommendation and guideline. So what are you to do? It almost seems hopeless! Many of you have turned to alternative sources of information, like VegSource.com. This is laudable in that you may have already realized the extent of Nutritional Confusionitis in mainstream culture. You're ahead of the curve. But how much ahead of the curve are you?

I'm sure you know that alternative sources of nutrition information are not always beacons of clarity and truth, to say the least. One website17 that otherwise promotes a diet rich in fruits and vegetables also promotes "Orthomolecular medicine," which they define as "the therapeutic use of high-dose vitamins to treat chronic disease." This is merely one example of thousands of websites, mass mailings, and supermarket products that claim a panacea of wondrous benefits for different types of supplements. It's not uncommon for half of the 'health' section of a supermarket to be stuffed full of supplements, all with a plethora of claims. It's not hard to see why a recent article4 cites a survey concluding that consumers find media information concerning vitamins and supplements to be among the most confusing of all medical and health information.

There are many other issues that are sources of confusion. For example, do you know if fish is good or bad for you? Are all fats bad for you, or are some types good and some types bad? Do you know what kind of nutrition or supplements pregnant women and children need for optimal health? Do you know whether environmental chemicals, such as those that are byproducts of factory processes, are the chief causes of cancer? Is organic meat and dairy safe to eat? Are organic foods, in general, better for you? Are all soy products good for you all the time, or can you overeat them? Is a raw foods diet the healthiest diet, and is it true that cooked foods could even be considered dangerous? And, by the way, is a plant-based diet really the healthiest diet? What if you include lean meat and low-fat dairy just three or four times a week?

If you look hard enough, alternative sources of information will offer you every answer to these questions you can possibly think of, and many more. As a result, even people who are diligently interested in health, people who are otherwise healthy, fit, and attractive, often suffer from Nutritional Confusionitis. Those who suffer from this horrible illness include vegans, vegetarians, omnivores, Atkins devotees, doctors, teachers, researchers, government decision-makers, and many more. The whole system is such that almost all of the general public, the official, 'credible' organizations and authorities, and the motivated alternative health seekers are afflicted to some degree or another.

It is a very challenging situation, to be sure, but since I began pondering this situation I have learned a few lessons that might ameliorate the effects of Confusionitis to some small degree. You see, I myself was once a victim of this disease. I wouldn't say that the disease had totally consumed me, mostly because I was fortunate to be born to two wonderful parents who brought me up to value a good diet and the health that results. Perhaps more importantly (after all, don't most people believe their parents knew what was best and taught them well, regardless of whether it's true or not?), one of those who produced me happens to be the famed researcher Dr. T. Colin Campbell of Cornell University, the Champion of the China Project, the Prime Promoter of Plant-Based Diets, the Heavyweight of Health, the old guy who falls asleep in front of the Newshour with Jim Lehrer with such regularity that putting stuff in his gaping, snoring mouth while he is sleeping became boring long ago.

And yet, despite being born into this goldmine of nutrition information, for most of my life I did not really understand nutrition and health. I couldn't justify my food choices and I didn't know the exact source of my beliefs, and yet, I somehow always knew that I was right! (An inflexible belief that is not borne out of careful consideration is a prime sign of Nutritional Confusionitis.) I had been vegetarian since I was about 11 or so, and always believed myself to be healthy, but when a friend once challenged me to explain one single study that showed diet to be related to cancer, I was reduced to essentially saying, "Well, my Dad said so." Pathetic! (I probably offered an explanation a little better than that, but not by much.) As it went so often in those probing, sometimes personally offensive discussions about my choice not to eat meat, I was left upset and feeling fully unable to defend my position in a satisfactory way to people who had no interest in being convinced. I dreaded the question, "So why are you vegetarian?"

Then everything changed. The transformation began when I started working with my father on a book about diet and health, and the sources of health confusion that permeate our society. I'm happy to report that this book, The China Study, was recently completed. It will have been three and a half long years from the beginning of this process to the time it hits the stores January, 2005. During this process my father and I talked endlessly about how best to communicate the value of good nutrition, how best to engage the interest of non-scientists, and how to organize a story that left the reader utterly convinced of our message. I went to the library and researched topics like diabetes, heart disease, obesity, industry influence on nutrition, and medical misunderstanding of nutrition, and ended up reading and sorting through literally hundreds of research articles, always discussing, and always trying to understand the questions that would inevitably arise. My father and I would write our own passages and then act as each others' editors. We argued incessantly, sometimes painfully, about what was important and what was uninteresting; what the average laypeople needed to know, and what was only included for the impossibly skeptical scientist. He often wrote for the scientist, and I acted as the translator for the layperson, inevitably having to cut out information. That would incite more arguments and more discussion. Round and round it went, year after year, until we earned the honor of saying we finished a book together.

After these years at home, learning the family trade, so to speak, I am no longer burdened so heavily with Nutritional Confusionitis. First of all, I realized that I hadn't been eating so well through college and the years following college. For example, I no longer eat my past favorite of Kraft macaroni and cheese with broccoli out of the pot. In fact, I no longer eat any dairy foods, except in rare instances, and I eat far more fruits and vegetables in general. In addition, I no longer fear that I won't be able to defend myself in those accusatory conversations about the way I eat.

That is not to say that I am cured of Confusionitis. I would be crowned the King of the Moronic People if I told you that I truly understand even a third of what there is to know about diet and health. It is a constant battle to be in a place where I see clearly, a place that is aware of my biases and limitations. For now, though, I am going to fight this good fight, so to speak. I'll do my part because I feel that aligning ourselves with good nutrition, without confusion, is the single most important thing our country can do to fix the disasters that we call mainstream health and medicine.

Of course, tackling all of the Nutritional Confusionitis throughout popular culture, medical care, and academic and government recommendations is an overwhelming, impossible task, so I'm only going to take it one person at a time. For myself, I'm going to be mindful of some of the lessons I've learned over the past few years:

Don't be afraid to say, "I don't know."

Spend time challenging those things that you think you do 'know'.

Try to refrain from forming inflexible opinions or dogmatic beliefs. Unless you have turned certain food groups into your personal, sacred saviors, and you regularly offer sacrifices and prayers to these food groups, try to remember that nutrition is not the almighty personal religion that so many people make it out to be.

Adopt strong opinions only after very serious consideration of the related information. Because your Mom, Dad, or other family member "said so" is not good enough. Because other people are doing it is not good enough. An article you read in a newspaper, magazine, or on a website is not good enough. In reality, no single source of information is good enough, unless that source is clearly explained and supported by many dozens, at least, of professional research findings that you trust. A good dose of skepticism is healthy in this effort, but don't let skepticism blind you to something you might learn from.

When someone tells you that they've lost 40 pounds eating only crab meat, coconuts, and ice cubes, and that they know that this is the natural diet, refrain from hitting them or telling them they are stupid. Instead, say, "Now that's an interesting idea," and mean it!

Listen to those who disagree with you, and try to find common ground. We might learn something from each other yet!

Continue to seek out more information.

This list of lessons is not complete, and you probably have amendments and variations of your own that you could add to my list, but I think it's a decent start. And although I'm not going to change the world overnight, or fix the problems of society, I think that I can improve my little corner of the world. Over time, if my corner of the world were to spread, nutrition might just become the premiere health science that it deserves to be. We might actually have a healthy, open-minded discussion about good nutrition unencumbered by corruption, sleazy special interests, and unswerving personal biases. We might have a population that learns how to love eating, and enjoy it with a passion, but also how to stay healthy, fit, and trim at the same time. We might have a population that avoids heart disease, and if not everyone chooses to avoid heart disease, they could at least have a chance to be treated by nutritional means, rather than be resigned to confine themselves next to the Philips HeartStart Home Automated External Defibrillator for the rest of their angina-filled lives. We might serve deliciously prepared fruits and vegetables in our hospitals, rather than chicken with a cream sauce, disgusting over-cooked vegetables, and cheesecake (A meal a friend of mine was recently fed in a cardiology care unit).

So as we start a new year considering food and health, I would like to suggest that if we are mindful of the way we act, what we believe, and how we form opinions regarding nutrition, we can make the world a better place and help those around us. We will know that we're moving in the right direction if we go to Amazon.com one day and find that toe-separators, even with their miserable sales ranking, are selling better than HeartStart Defibrillators. And as long as that future might be reality, it is a future worth rallying behind.

Thomas M. Campbell II, a 1999 graduate of Cornell University, is a writer, actor, and two-time marathon runner. He and his father recently completed the book, "The China Study: the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health," which is available online and due in stores this month.